A health worker takes a woman’s blood pressure at a primary health center. Photo by: H6 Partners / CC BY-NC-ND

NEW YORK — Continued progress on decreasing fertility rates and family size is dependent on health systems providing universally accessible reproductive health services, according to the United Nations Population Fund 2018 “State of the World Population: The Power of Choice: Reproductive Rights and the Demographic Transition” report.

Family size is closely linked with reproductive rights, which are then tied to many other rights, such as employment and health — and no single country can claim that all of its citizens have full access to reproductive rights at all times, according to the UNFPA report released on Wednesday.

“It is about ensuring that all people are able to exercise their rights and choose the number and timing of pregnancies and how global fertility trends are influenced by choice or lack of it,” said Sarah Craven, UNFPA Washington, D.C., office director.

“There is no place where everyone’s reproductive rights are fully being enjoyed, by all people, at all times. Someone may not have access to contraception because of a lack of education, or in a low fertility country, someone might want to have more children but cannot do it because they cannot afford it and do not have childcare.”

Approximately 214 million women in developing regions want to avoid pregnancy but are not using a modern contraception method, according to the Guttmacher Institute. And unsafe abortions are a leading cause of death during pregnancy worldwide.

A majority of countries with populations of 1 million or more have fertility rates of 2.5 children per woman or lower, according to UNFPA, and gaps between different regions have largely closed between 1990 and 2015.

But progress remains unsteady. Fertility, for example, has varied across sub-Saharan Africa over the past 50 years, now the region is on track to contribute to more than half of the world’s population growth to 2050.

Niger has the highest fertility rate of 7.1 children per woman, while Taiwan has the lowest rate of 1.1 children per woman. That falls below the replacement level, or the average number of children born per woman at which a population can replace itself without migration.

The report roughly divides countries into four categories: Countries with high fertility rates; countries with rates that have fallen and then plateaued or increased again; countries with steadily declining rates; and countries that have long had low fertility rates.

While much of sub-Saharan Africa and other countries with a history of conflict have rates of more than four births per woman, developed countries in Asia, Europe, and North America have long had low fertility rates.

The challenges in individual countries vary, but there is at least one common denominator to reducing fertility rates: Access to reproductive rights.

“The universal character of reproductive rights, the international commitments to them, and the interrelationships between fertility and development mean that remaining barriers must fall, especially if we are to achieve the 2030 Agenda for Sustainable Development,” the report reads.

The publication of these findings comes nearly 25 years after the International Conference on Population and Development took place in Cairo, where governments and civil society agreed that the right to plan one’s family is key to development.

There has been a lot of momentum and movement [following the conference and its plan of action],” Craven said. “Have we fully realized it? No. do we have a long way to go? Yes.”

About the author

  • Amy Lieberman

    Amy Lieberman is the U.N. Correspondent for Devex. She covers the United Nations and reports on global development and politics. Amy previously worked as a freelance reporter, covering the environment, human rights, immigration, and health across the U.S. and in more than 10 countries, including Colombia, Mexico, Nepal, and Cambodia. Her coverage has appeared in the Guardian, the Atlantic, Slate, and the Los Angeles Times. A native New Yorker, Amy received her master’s degree in politics and government from Columbia’s School of Journalism.